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Home My WebLink About04-16-15 °°°�"° °F ,"°'°'°'�� ^'E� Penns Ivania lnheritance Tax �� Pennsylvania PO BO% 000601 � OEGPflTMENT OF qEVENUE HRRRISBORG PA Ilp9-�6Y1 Information Notice And Taxpayer Responsa "'°," .`�"`° - RE ORDFD GFF!CE Of Fi�ENo.zi-iS-ptJ25 ACN 15118851 � R ^",'."� ,.� 171LLS onreoa-m-zois ��5 PPt� 16 �� 1 �17 TypeofAccoun� �I � �� Es�ate of GARV A FRV Savings � Checking ORPr . �:� ''daceoroeamoai3-zoia Tr�s� JOANNE M PRV ��t -CounryCUMBERLAND Certificate 6403 LEXINGTON OR " ' MECHANICSBORG PA 17050-1934 SANTANOER BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or bene(iciary of ihe account identified. Remi�Payment and Forms to: AccountNo.574104121 Date Established 0341-1988 HEGIS7ER OF WIILS Account Balance $1,12q.39 1 COURTHOUSE SOUARE Percent Taxable X 50 CARLISLE PA 17013 Amowt Subject to T� $56220 Tax Rate X 0.150 NOTE': If tax payments are made wRhin three mon�hs of the Potential Tae Due $84.33 decedenPs date of death, deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance lax due will become delinquen�nine months afler ihe date of death. PART SteP 1 : Please check the appropriate boxes below. 1 A �lo tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed ro Sfep 2 on reveree. Do not check any other bozes and disregard the amount shown above as Potential Tax Oue. g �The information is The above informa�ion is correct, no deductions are being taken,and payment will be sent correc�. with my response. Pmceed to Sfep 2 on reverse. Do nof check any othei boxes. p �The tan rate is incorred. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of[he tleceased. (Select correct�ax rate al right, antl complete Part � �p� I am a sibling of ihe deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The information above is inwrrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back ol this lorm. E �Asset will be reported on The above-identified asset has heen or will be reported and tau paid with ihe PA Inheritance Tax inheritance tax form Retum filed by the estate representative. REV-1500. Pmceed to Sfep 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. � PApT Debts and Deductions 2 Allowable deb�s and detluctions must meet both of�he followin9 criteria: A. The decedent was legalty responsible for paymenL. and[he estate is insuHicient[o pay the deductible items. B. You paid�he debts afler the death of the deceden�and can furnish proof of paymen�if reques�ed by the depatlmen�. Qf addltional space is required,you mey atlach 8 1/2"x 11"sheets of paper.) Date Paid Payee Descrip�ian Amoun� Paid Total (Enter on Line 5 of Tax Calwla�ion $ PART Tax Calculation 3 H you are making a correction to the esWblishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a writlen correction from tfie tinancial institu[ion and atlach it to this torm. 1. Enter the date the account was established or tiUed as it existetl at the date of death. 2. Enter ihe total balance of the account including any interest acemed at the date of death. 3. Enterthe percenta9e ofihe accountthatistaxableto you. a. Firsl,de�ermine the percen�age owned by�he decedent. i. Accounts that are held "in imst for"another or others were 100%owned by the decedent. ii. For joint accounts establishetl more than one year prior ro the date of death,the percentage[�able is 100%divided by�he to�al number of owners including�he decedent. (Por ezample:2 owners= 50q, 3 owners=33.33%,4 owners =25%,etc.) b. Next,divide�he decedenYs percentage ownetl by�he number of surviving owners or bene(iciaries. 4. The amount subjed to�ax is deiermined by mul�iplying the account balance by the percent taxable. 5. Enter[he total o�any deb�s and deductions claimed�rom Patl 2. 6. The amount taxable is determined by subiracting the debis and deductions from the amount subject to tax. Z Enter the appropriate tax rate from Step 1 based on your relationship ro the decedent. Ii indicating a diflerent tax rete,please state '�-,� �� ,��, + *+�.,. your relationship to the decetlent �: �� . '3-e`* 1. Da�e Eslablished 1 v ��,"��,y� ^' �,{.: V �` +'" ��*��`��'�C �� `n'�v5 .+ �k.Y f x�i4�� , .�..�� 2. Accoun� Balance 2 S � * k�- 5 ci � � ""* ,.ix+wtn�'� ..� =s�'x��Ye. 3. PercentTaxable 3 X � ,q �^�` �u ,�y .��_^^ _.3."+...� .� ,b�r rS�"v�� 4 � ,�� 4_ AmountSuhjec�toTax 4 $ �� 7��'��f4�""'�Yac� _ �, ��_ ,�yxE S Deb�s and �educ�ions 5 - s} .��y.� Vq„'Z e+� � dw 1,1, f + , s . # �e �.u�, t '� �a, .s.�... 6. Amount Taxa6le 6 $ , ;,�� ; =.�. �� . Tax Rate � X � r.` '�' 4' ;-�: .w- .._..:. c 8. T� Due e $ $ �t "yT3'� � � �' `��, ��. 9. Wi�hS% Discoun[(Taxx .95) 9 X '`.;«, +L.d ._ .»a � St2P 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are makin9. Checks musl be made payable to"Register of Wilis,Agent" Do nol send payment directly to the Department of Revenue. Under penalry of perjury, I tleclare Ihat the facis I have reported above are true,correct and complete ro the best of my knowledge and belief. WOfk -( i 7' (:`t 7- 9�YS � — HOme �7- �47- 91YS �-j- �'l.� axpayer Signa e Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 �' � a� - � . � � _ � � � - � r _ � � � = �c � � _- � �, a � c �� J 'r, �•, � �; ~— ;,: �awn6 , �bo _ . � � Sn t �� °t ��'d SICi .:< Slll;�, _� _� �:'." ��I;i3H LL�o j0 3�i�:� u�uilOJ3U `�� a$� l� euaenu oc �xomow� *nxes Pennsylvania lnheritance Tax �� Pennsylvania XPO N�IS OXG6YA e e v�ae osoi If1(�ffildllOfl NOIICE � �EPNRTMENT Of PEVENIIE And Taxpayer Res onse "�-""`•�"•" ' RECORu�G CFFP�E OF Fi�ENo.zi -i5 py25 ACN 15118852 RrGig'S;1 �- •;"�� S oaTeoa-o�-zois 2015 flPR 16 °fl 1 `i9 Type of Accoun� ��r�Estale'of GARY A FRV Savings ��PFi��,�''�aeolDeath04613-2014 Tustking J�ANNE M FRV �(J�f��_' .. COUn[yCUMB�RLANO Certiticate 6403 LEXINGTON DR MECHANICSBURG PA ll050-1934 SANTANDER BANI( provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: AccountNo.1681701456 Date Established 06-16-1982 REGISTER OF WILLS Account Balance $1,q3722 7 COURTHOUSE SOUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tae $718.61 Tax Rate X 0.150 NOTP: If tax paymen�s are made within three months o�the Potential Tae Due $1�779 decedenYs date of death, deduct a 5 percent discount on[he�a< With 5%Discount(Tax x 0.95). $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A �lo tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date ot death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct, no deduc[ions are being taken, and payment will be sen[ correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.) of the deceased. (Select correct�ax rate at righl,and complete Patl � �2� I am a siblinq o�[he deceased. 3 on reverse.) � 15% All other rela�ionships (including none). p ❑Changes or deductions The information above is incorrect and/or deb�s and deductions were paid. listed. Complete Part 2 and part 3 as appropnate on the back ol this lorm. E �Asset will be reported on The above-identifed asset has been or will be reported and tax paid with ihe PA Inheritance Tax inheritance tax form ReWrn filed by the es�ate represen�ative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. � Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for paymenL and Ihe estate is insuflicient to pay ihe deduditle items. 8. You paid the debts aiter the death of ihe decedent and can fumish pmof oi payment if requested by the department. (If atlditional space is required, you may attach 8 1/2"x 11"sheets of paper.) Da�e Paid Payee Description Amoun� Paid To�al Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 Ii ou are makin a correction to the establishment date Line 1 account balance Line 2 ,or y g ( ) ( ) percent taxable(Line 3), please obtain a written wrrection from the tinancial institution antl atlach it to thfs torm. 1. En�er the da�e the account was es�ablished or titled as i�exis�ed a�Ihe date of death. 2. En�er ihe total balance of the account including any interest accrued at[he da[e of dea[h. 3. Enterthe percentage otthe accoumthatis�axableto you. a. First,determine the percentage owned by the decedent. i. Accounis ihat are held"in tmst for"another or others were 100%owned by ihe decedent. ii. Por joint accounis established more than one year prior to the date of death,the percentage ta<a61e is 100%divided by ihe total number ot owners including the decedent (For example:2 owners= 50%,3 owners=33.33%,4 owners =25%, etc.) b. Next, divide the decedenfs percentage owned by ihe number of surviving owners or beneficiaries. 4 The amount subject ro tac is determined by multiptying ihe account balance 6y the percent taxable. 5. En�er�he total o�any debts and dedudions claimed fmm Patl 2. 6. The amount taxable is determined by subhacting the debts and deductions imm the amoun�subject�o tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the deceden[. If indicating a diflerent tax rate, please state t �� _� � 1'N'a�:t' � iour relationshi to ihe decedenC * � �e �'� . oare es�atrsned i " '��s� ��'�� arr `�e.�a ,a� 's#;t r t��'�}`� ','. a+43 r�: 2 Account Balance z $ P�� 3. Percant Taxable 3 X � `�`._`� � ;� -�td .�i� � ?�= 2 �<-�'�'��: , s,� d .1 t 5 �4+ 4. Amount Sublect to Tax 4 $ 3 � �"�, �s S Debis and Deductions 5 - b � ,.��.��„g,� y}�� .- 6. Amount Taxable 6 $ � .,�,��}�i ;�,�„��, � . r� ;,d �. rax ae�e � x 6 �.��-..�:.-.�-a-;.,��ru�s�-�3��. .: . � .,:,t��',itr , .,A 8. TaxDue 8 S $ ._ . �. � � +�� 9. With 5% Diswunt(Tax x .95) 9 X .u.,..,...,+r.�u�., ui�:., i„�..:�, $tEP 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on ihe iront of ihis form, along with a check for any paymen�you are making. Checks mus�be made payable to"Regis�er of Wills,AgenL" Do not send payment directly to ihe Department of Revenue. Under penalty of perjury, I declare ihat Ihe facls I have reported above are true,correct and complete ro the best of my knowledge and belief. WOrk 7/-7- �`L�7- 4�2YS _ � — Home 17- Co47- 9a4S �(- � -[ - axpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 i � ne & RECORCE� rFFICE OF a6s z �Rcr,.c.'_ . � .':'_LS I � I �o 2p15 P�PR 16 °i� 1 y9 O RF'.'.r CUM�E � .. ;: � c.i � _ � `a � c 41 � � �l) � n� �, � � � _ � �� _ _ � � I � = V � _ �' = � 's � - �;.�� = � _ � . � a�a�^� �F ��^��^�^� *^xFs Pennsylvania lnheritance Tax �� Pennsylvania PO 60X 200601 pEPPFTMENTOfFEVENIIE NAPNISBORG PR IR39-0601 Information Notice And T�payer Response pi�E v0.zr��y-D�25 ACN 15118853 � tU Utr�UC vr DATE04-07-2015 REGiS7��.�, . :� `':9LLS Type oi Account 201.5 PPR 16 'fl � y�state of GARV A FRY sa��oys Checking C L!�-�� . � Date of Death 04-13-2014 Tmst JOANNE M FRV ��p��. �.�� ;�T CountyCUMBEFLAND CEhificate 6403 LE%INGTON DR � MECHANICSBUR6 PA 17050-({��i�"". - ., , . , SANTANOER BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms[o: ACcounl No.247406W76 Date Established 12-12-2008 REGISTER OF WILLS Accoun�8alance $390.07 1 COURTMOUSE S�UARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $ 195.04 Tax Rate X 0.150 Potential Tvc Due g pg_pg NOTE': If tax paymen[s are made within three monihs of the decedenYs date ot death,tleduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax tlue will become tlelinquent nine months aflerihe date ofdeath. PART St2p 1 : Please check the appropriate boxes below. 1 A �lo tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed fo Step 2 on reverse. Do nof check any ofher 6oxes and disregard fhe amoun! shown a6ove as Potential Taz Due. g �The information is The above information is correct, no deductions are being taken, and payment will be sent correct. with my response. ProCeetl to Step 2 on reverse. Do not cheCk any other boxes. p �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etcJ of the deceased. (Select correct tax rate at right,and complete Part � �p� I am a sibling of ihe deceased. 3 on reverse.) � 15% All other relationships (including none). p �Changes or deductions The information a6ove is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriafe on the back ol this lorm. E �Asset will be reported on The above-iden�i�ied asset has been or will be reported and tav paid with the PA Inheritance Tau inheritance ta<form ReNm filed by the estate representative. REV-1500. Pmceed to Step 2 on reverse. Do not check any ofher boxes. Please sign and date the back of the form when finished. � PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The tlecetlent was legalty responsible for payment, and Ihe estale is insuHicient to pay ihe deductible items. B. You paid the debts after ihe death of ihe tlecetlent and can Wmish pmof of payment if requested by the department. Qf additional space is required, you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amoun� Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a cortection ro the establishment date Line 1 account balance Line 2 ,or y g ( ) ( ) percent taxable(Line 3), please obtain a writlen correction irom ihe financial institution antl attach it to this form. t Enter the date ihe account was established or titled as it existed at the date of death. 2 Enter the total balance of the account induding any interest accruetl at the date of death. 3. Enter ihe percentage of the account that is taxable to you. a. First,determine Ihe percentage ownetl by the decetlent. i. Accounts[hat are held"in tmst for"another or others were 100/awned by the decedent. ii. For join�accounts established more ihan one year prior to the date oi death,the percentage tavable is 100%divided by the btal number of owners including[he deceden�. (For example:2 owners=50%,3 owners=33.33%,4 owners =25%, etc.) b. Next, divitle the tlecedent's percentage owned by ihe number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiptying the account balance by the percent taxable. 5. Enter ihe rotal ot any debis and deductions claimed irom Part 2. 6. The amount taxable is determined 6y su6hacting the debts and deductions irom the amount su6ject to ta�c. Z Enter ihe appropriate tvc rete from Step 1 based on your relationship ro the decedent. It indica[ing a different tax rate, please state ' n""�5u. �"�jg��...� �, � ��, �d your rela�ionship to the decedent: � � R � ,��^ - 1. Date Esta617shed 1 .� '�` ��T��U ^�s"r'"� ��, x�.��ms��,��a��q�`� ' k�°�`4� .Y,r. x. 2. Account Balance 2 $ � +" 1�� : � x#��`� 3. PerceniTaxable 3 X ^=-; � T� .� #�5a . ' 2 x�. ; �m ,.v.�. � .. � s . 4. Amount Suble��o Tax 4 $ �` .,� 5. Debts and Deductions 5 - �� ,,„��: � ;�'��s�� 6. Amount Taxable 6 $ � � ��x�� -�� - -ires .n:c3�s�,;` s.rr �,��` 7. T� Rate 7 % s ,�iy�: �.- a � e. TauDue 8 _$_—_- _- —. 8 ?2��i �, � �s.� *. �. .. �� 9. Wi�h5% Discount(Taxx .95) 9 X �,�r?„, „��,k,„,., rn '� � St@P 2: Sign and date below. ReWrn TWO completed and signed copies to the Register of Wills listed on Ihe front of this form, along with a check for any payment you are making. Checks must be made payable to"Fegister of Wills,AgenL" Do not send payment directly to Ihe Depatlment of Revenue. Under penalty of perjury, I declare that the facts I have repotled above are tme.. correct and complete lo ihe best of my knowledge and 6elief. Work Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 RECORE_D GF`ICE OF . . . � � REG,>T�"'_. . " . ,'._i_S. _ 7g15 fiPR 16 ''fl 1 49 = c.t_ _ = oa=��r.�, , �u�r = cu�+.a�, � ^.. �", _ ��,�, — : 1 a = � �,� � = � � �� ' = -, � _ � � � _ � .� �, _ r � � � � � ,•, � ,� `� �� 1", �/ ` N! /A/ l0 ` Y .+ (J 9� �p`a Y �gd '$ � Z ,�R�� aF ,„o,�,o�,� ..xEs �i� pennsylvania po aox �aobp� Pennsylvania lnheritance Tax xr�xa�seuaevn v�ze-oso� InformationNotice �3� oePnarnervroraevervue And TaxpayerResponse RE ORC�D G:-FICE OF Fi�eNo.zi_�y-�t�ZS ACN 15118850 (? -�I$7�7. '.'= '.:;'��fS DATE04-07-2�15 70':5 PPR 16 °I'1 1 `i9 rvPeorn000�rn C L �F Esta[e of GARV A FRY Savings ORPuF � ��.��eofDeath0461&201a Tmstkmg JOANNE M FRY Q��j�'.ri C6uq�yCUMBERLAN� CetlifiCa[e 6403 LE%INGTON DR MECHANICSeURG PA 17050-1934 SANTANOER BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. AccOunt No.571111211 Hemit Payment antl Forms to: Date Established 0623-1993 REGISTER OF WILLS AccouniBalance $776.56 1WURTHOUSES�UARE Percen[Tauable X50 CARLISLE PA 17013 Amount Subject to Tax $38828 Tax Rate X 0.150 Potential Tau Due g Sg.pq NOTE': If tax payments are made within Ihree monihs of Ihe decedenfs date of death,dedua a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine monihs atter the date of tleath. PART StBP 1 : Please check ihe appropriate boxes below. 1 A [�lo lax is due. I am the spouse ot the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on Bverse. Do not check any other boxes and disregaid the amount shown a6ove as Potential Tax Due. g uThe informa[ion is The above information is correct, no deductions are being taken, and payment will be sent correct. with my response. Proceed ro Step 2 on reverse. Do not check any other boxes. p �The tax rate is incorrecL � 4.5% I am a lineal beneticiary(parent,child,grandchild,etc.)of the deceased. (Selec�correct tax rate at right,and complete Part � �p/ I am a sibling of ihe deceased. 3 on reverse.) � 15% All other relationships(including none). p �Changes or deductions The information above is incorrect and/or debis and deductions were paid. listed. Complefe Part 2 and part 3 as appropriate on the 6ack ol this loim. E �Asset will be reported on The above-identified asset has been or will be reported and t� paid with Ihe PA Inheritance Ta�c inheritance ta<form ReNm filed by ihe estate representative. REV-1500. Pmceed fo Step 2 on reverse. Oo not check any other boxes. � Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable deb�s and deductions must meet both of the following cri�eria: A. The decedent was legally responsible ior payment, and the estate is insuflicient to pay[he deductible items. B. You paid Ihe debts afler the death of the decedent and can fumish proof of payment if requested by the department. (Ii additional space is required,you may atlach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 ot Tax Calculation $ PART Tax Calculation 3 H ou are makin a conection to ihe establishment date Line 1 account balance Line 2 ,or y g ( ) ( ) percent taxable(Line 3), please obtaln a writlen correctlon from ihe tinanclal Institution and atlach it to this torm. t Enter ihe date the account was established or titletl as it existed at the date of death. 2 En[er the rotal balance of the account inclutling any interest accmetl at the date of death. 3. EMer the percenta9e of the account that is taxable to you. a First,determine�he percentage owned by the decedent. i. Accounts that are held"in hust�or"another or others were 100%owned by�he deceden�. ii. Forjoint accounts established more than one year prior m[he date of dealh, �he percentage taxable is 100%divided 6y the total num6er of owners including lhe decedenL (For example:2 owners= 50%, 3 owners=33.33%,4 owners =25%,e�a) b. Next, divide the decedenPs percentage owned by the number of surviving owners or beneficiaries. 4. The amount sublect to ta�c is determinetl by multiplying the account balance by ihe percent taxa6le. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is tleterminetl by sub�racting�he deb[s and deductions imm the amoun�subject to tau. 7. Enter the appropriate tax rate irom Step 1 basetl on your relationship ro the decedent. If indica[ing a diflerent lax rete,please state „� ". K� x ta,:t�,� xk } your relationship to ihe decedenC �`�''�4�'� k � �n' a �} zy 1. Da�e Established 1 ��.� �� '�'� � � {p„ 2. Account Balance 2 $ ��-i �� a.+�e s�-'�' :ar'� ;S .`> 3. Percent Taxable 3 X 2`� � �� x: +4 ,s 4. Amounl Subject�o Tax 4 $ , y .�� '' x « +" �a &r .. c},y. 5. Debts and Deductions 5 - ��, 4 . �,`� �i v-�� ^��y�.F � 4`} s;y.. 6. AmountTaxable 6 $ � '� ��"'�� * ;�.. 3^��`�'P . +:v t'" '�.� "".ii5'e. 7. Tax Rate 7 X �t"` �: R ��. +a-`'-..y�.'�""" # s,rw,: _ .�an� 8. Tax Due e $ g r�.4 ,� �.i. Q� 9. With 5%Discount(Tax x .95) 9 X . .,,i,� . „;:..„u-,s. . .Step 2: Sign and date below. Return TWO completed and signed copies to ihe Register of Wills listed on the fron�of this form, along wi[h a check for any payment you are making. Checks must be made payable ro"Register of Wills,AgenL" Do no[send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the tacts I have reported above are ime,correct and complete to ihe best ot my knowledge and belie�. work —��- �t 7- raYS - Home �r 47- `rd— - � -�S aupayer Signature Telephone Number Date , IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. 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